Claims Adjuster - Workers Compensation

Job Title: Claims Adjuster - Workers Compensation
Location (On-site, Remote, or Hybrid?): Denver, CO (remote)
Contract Duration: until 02/20/2027

PRIMARY PURPOSE:
To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.


Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.



ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• Administers subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

SKILLS

• Performs other duties as assigned.
• Supports the organization's quality program(s).

EDUCATION
Bachelor's degree from an accredited college or university preferred.


Travels as required.


Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations



WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.


Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines


Physical: Computer keyboarding, travel as required


Auditory/Visual: Hearing, vision and talking